Form 1099-C - Cancellation Of Debt - 2018 Page 3
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1
2
3
4
5
6CORRECTED (if checked)
CREDITOR'S name, street address, city or town, state or province, country,
1 Date of identifiable event
OMB No. 1545-1424
ZIP or foreign postal code, and telephone no.
Cancellation
2018
2 Amount of debt discharged
of Debt
$
3 Interest if included in box 2
1099-C
$
Form
Copy B
CREDITOR'S TIN
DEBTOR'S TIN
4 Debt description
For Debtor
DEBTOR'S name
This is important tax
information and is being
furnished to the IRS. If
you are required to file a
return, a negligence
5 If checked, the debtor was personally liable for
Street address (including apt. no.)
penalty or other
repayment of the debt
.
.
.
.
.
.
.
.
▶
sanction may be
imposed on you if
City or town, state or province, country, and ZIP or foreign postal code
taxable income results
from this transaction
and the IRS determines
Account number (see instructions)
6 Identifiable event code
7 Fair market value of property
that it has not been
reported.
$
1099-C
(keep for your records)
Form
Department of the Treasury - Internal Revenue Service
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Parent category: Financial